Electroacupuncture for temporomandibular disorder-related pain: clinical evidence, mechanisms, and safety-a narrative review.

Temporomandibular disorder (TMD) is a common and complex disease characterized by pain, noises in the joints, and dysfunction of the mandible, significantly impacting the patient's quality of life and day-to-day functioning. Electroacupuncture (EA), which is a combination of conventional acupuncture and electric current, has emerged as an important non-pharmacologic treatment modality for the management of TMD-associated pain. In this narrative review and comprehensive synthesis, we have discussed in detail the clinical evidence, mechanisms, and safety profile of EA for treating TMD. While evidence from RCTs and SRs suggests that EA is an effective intervention for alleviating pain, its relative superiority over manual acupuncture or sham controls should be interpreted with caution due to the observed heterogeneity in study designs. Structured analysis reveals that EA not only addresses physical pain but also potentially improves emotional distress, sleep quality, and functional outcomes, though the efficacy and effect sizes are highly contingent on the specific clinical protocols and TMD subtypes included in the trials. EA may relieve pain through various mechanisms by affecting the processing of neuropathic pain involving activation of Aβ and Aδ fibers, enhancement of the local blood flow and tissue regeneration, and immunomodulation through suppression of pro-inflammatory cytokines. EA has a good safety record, with mostly minor and short-lived side effects (pain at site or ecchymosis) and no serious complications reported to date. The clinical implementation of EA, however, requires standardization of treatment protocols, adequate practitioner training, and additional rigorous studies using large-sample, multicenter trials with prolonged follow-up in order to optimize the parameters and confirm long-term benefits. In conclusion, current evidence suggests that EA is a safe and potentially beneficial integrative modality for TMD pain management. While it appears promising as part of holistic care to reduce reliance on traditional medications, further high-quality studies are required to confirm its definitive long-term superiority and effectiveness.